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Democrats, health groups warn against rollback of discrimination protections in comments submitted to the Trump administration.

The Trump administration's 'public charge' rule draws the first in what's expected to be a wave of legal challenges.

A message from the American Hospital Association:

America’s hospitals and health systems have heroically met the challenges caused by COVID-19 while sustaining $50B in losses a month. Learn more.

WELCOME TO WEDNESDAY PULSE — Where your California scribe is still trying to wrap her head around the efforts last night by Acting Director of Citizenship and Immigration Services Ken Cuccinelli to explain how he's not rewriting the famous words inscribed on the Statue of Liberty to address immigrants who will become a "public charge." Tomorrow, your regular host, Dan Diamond, will be back on. Please send tips and poetry rewrites to [email protected]

"The consensus at this point is that the response will be 'polite f-u letters,'" a lawyer for Heritage wrote in one October 2014 email to CEO Jeffrey Glazer after speaking with counsel for Mylan and Teva, which had received similar letters from Cummings and Sanders.

Sanders and Cummings are sending letters to the companies seeking answers about the original price increase — details about hikes as high as 500-percent margins that they'd originally asked for — plus explanation on the "evasion and obstruction" that followed. The three companies did not immediately respond to requests for comment Tuesday night.

DEMS, AGs REGISTER DISSENT ON ANTI-DISCRIMINATION ROLLBACK —Hundreds of organizations and politicians on Tuesday submitted comments on HHS's planned reversal of an Obamacare provision intended to bar health care discrimination based on sex. LGBTQ advocates have warned that the proposed move — sought by the administration's Christian conservative supporters — would allow discrimination against transgender patients.

"HHS is abdicating its responsibility to enhance and protect the health and well-being of all Americans," Senate HELP Committee ranking member Patty Murray and more than 30 Democratic colleagues write in a letter shared first with PULSE.

California Attorney General Xavier Becerra and Massachusetts Attorney General Maura Healey also led a coalition of 22 attorneys general in opposition. In their letter to HHS Secretary Alex Azar, the AGs assailed the administration’s particular “hostility” toward and “reckless disregard” for the health of LGBTQ patients, and argued that the proposed changes will increase costs to the states.

— Multiple industry officials also said the move would be harmful. "Removing references in the rule to discrimination based on gender identity, sex stereotyping, and pregnancy status is inconsistent with providing access to affordable high-quality care to everyone," AHIP warned ahead of Tuesday‘s comment deadline. "Those changes should not be finalized."

In the Courts

LAWSUITS FILED OVER ‘PUBLIC CHARGE’ RULE — San Francisco and Silicon Valley’s Santa Clara County jointly filed the first lawsuit Tuesday over the Trump administration’s rule — set to go into effect Oct. 15 – that would curtail the ability of legal immigrants to obtain green cards if they are on Medicaid or receive other types of government financial assistance.

The filing, in federal court in San Francisco, calls the new rule harmful and unlawful and said it would “starve the counties of the resources needed to protect their residents’ health and well being.” The plaintiffs also assert the administration didn't present an adequate rationale for the new regulation, which they contend will have negative health consequences and undermine social safety net programs.

The state of New York, Connecticut, the Los Angeles-based National Immigration Law Center and others have also have vowed to sue over the new policy.California's AG Becerra told CNN's Anderson Cooper last night that the state is "prepared to file" a lawsuit as well.

Eye on FDA

FDA TO ASSESS MENU-LABELING RULE —On the FDA’s to-do list: checking in on how well industry has been complying with menu labeling requirements that kicked in more than a year ago, Helena Bottemiller Evich reports for Pro readers. The agency said Tuesday this includes making sure businesses are disclosing calorie counts on menus and on signs adjacent to foods on display.

In the States

TEXAS UPGRADES ITS PSYCHIATRIC HOSPITALS .. BUT...— The $1 billion makeover and increase in in-patient psychiatric beds is clearly something mental health experts can get behind. But, as POLITICO’s Renuka Rayasam writes for Pro, here’s the catch: the state hasn’t committed additional funds for more doctors, nurses and other staff to tend to the patients.

The plan is to add 350 new beds by 2023, which could relieve months-long waits for treatment while patients crowd emergency rooms and jail cells. That can only go so far, said Greg Hansch, executive director of the National Alliance on Mental Illness in Texas: "Building new state facilities only has its intended impact if you can attract enough providers to work in those new facilities."

NY DOCTOR PLEADS GUILTY IN OPIOID DEATH —A New York physician who held himself out as a pain specialist pleaded guilty Tuesday to a manslaughter charge in connection with a patient's overdose death.

The state attorney general's office said 61-year-old Barry Sloan — who prosecutors say prescribed "risky and addictive drugs" like oxycodone more than 70,000 times — admitted to recklessly causing the death of a 36-year-old Manhattan man by prescribing fentanyl. He’s expected to serve four to nine years in state prison.

The State of Marijuana

UNIVERSITY PARTNERS WITH DEA-APPROVED COMPANY ON CANNABIS RESEARCH — The University of California at Davis is teaming up with Biopharmaceutical Research Co. to analyze the chemical and biological profiles of cannabis to help government authorities better regulate the substance, help health professionals find new treatment options and researchers identify crop management strategies that protect the environment.

The partnership between the university and the DEA-registered company, considered one of the first of its kind, will rely on legally-acquired cannabis from the company and the research will focus on tetrahydrocannabinol or THC, cannabidiol or CBD, and other cannabinoids. UC Davis is also launching a Cannabis and Hemp Research Center later this year.

Obamacare

A CONSERVATIVE PERSPECTIVE ON OBAMACARE PREMIUMS —Yes, health care premiums are falling – but a new Heritage Foundation report attributes that largely to seven states that have obtained 1332 waivers to opt out of certain ACA requirements. The report calls for “more relief from Obamacare’s burdensome restrictions” and to “reject calls to spend more federal money on the health law.”

A message from the American Hospital Association:

America’s hospitals and health systems have stepped up in heroic and unprecedented ways to meet the challenges caused by COVID-19. However, the fight against this virus created tremendous financial crisis, saddling hospitals with $50B in losses per month. Early support from Congress and the Administration has helped but many hospitals remain on the brink. They need additional resources to continue delivering the critical care that patients and communities need while preparing for new challenges presented by the pandemic and resulting economic emergencies. Learn more.

No more than a quarter of residents in any state support a total ban on abortion, according to a report in the Washington Post. That's according to a survey released Tuesday by the Public Religion Research Institute that's considered the largest survey on attitudes toward abortion

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About The Author : Victoria Colliver

Victoria Colliver is POLITICO Pro’s California-based health care reporter. Before joining POLITICO, Victoria had been writing about the health industry and medicine for the San Francisco Chronicle since 2001. Prior to the Chronicle, she worked for the San Francisco Examiner and the Oakland Tribune.

A graduate of UC Davis, Victoria earned a master's degree in journalism from Columbia University. She had an Inter American Press Association fellowship to Venezuela, was a Fulbright scholar in Madrid, Spain and is a longtime member of the Association of Health Care Journalists. A native of the San Francisco Bay Area, she lives in Oakland.